Postpartum Changes

As the postpartum period sets in, the greatest change that the woman would notice in her is the change in her role; she is now a certified mother! With this modification, other changes will start to set in slowly and gradually, and the woman must be armed with information so she would be able to deal with these life changes.

Psychological Changes

The changes that the woman undergoes are crucial within the first 24 hours of postpartum, especially the psychological changes. These changes might affect the woman permanently if not given the appropriate attention and care.

Taking-In Phase

  • The taking-in phase usually sets 1 to 2 days after delivery.
  • This is the time of reflection for the woman because within the 2 to 3 day period, the woman is passive.
  • The woman becomes dependent on her healthcare provider or support person with some of the daily tasks and decision-making.
  • This dependence is mainly due to her physical discomfort from hemorrhoids or the after pains, from the uncertainty of how she could care for the newborn, and also from the extreme tiredness she feels that follows childbirth.
  • The woman prefers to talk about her experiences during labor and birth and also her pregnancy.
  • The taking-in phase provides time for the woman to regain her physical strength and organize her rambling thoughts about her new role.
  • Encouraging the woman to talk about her experiences during labor and birth would greatly help her adjust and let her incorporate it into her new life.

Taking Hold Phase

  • The taking hold phase starts 2 to 4 days after delivery.
  • The woman starts to initiate actions on her own and making decisions without relying on others.
  • Women who underwent anesthesia reach this phase only hours after her delivery.
  • She starts to focus on the newborn instead of herself and begins to actively participate in newborn care.
  • Demonstrate newborn care to the mother and watch her do a return demonstration of every procedure.
  • The woman still needs positive reinforcements despite the independence that she is already showing because she might still feel insecure about the care of her child.
  • Allow the woman to settle in gradually into her new role while still at the hospital or healthcare facility because making decisions about the child’s welfare is a difficult part of motherhood.

Letting Go Phase

  • During the letting go phase, the woman finally accepts her new role and gives up her old roles like being a childless woman or just a mother of one child.
  • This is the phase where postpartum depression may set in.
  • Readjustment of relationship is needed for an easy transition to this phase.

Physiological Changes

Several body systems are also affected after the birth of the newborn, and these changes may or may not be noticed by the mother early during postpartum.

Reproductive System

  • Involution occurs during postpartum wherein the reproductive organs return to their nonpregnant state.
  • The area where the placenta was implanted is sealed off to avoid bleeding.
  • The uterus returns to its prepregnant size.
  • Involution occurs more quickly in women who are well nourished and ambulate early after birth.
  • Contraction plays a very important role in the postpartum period for it allows the uterus to return to its former size quickly and also prevents hemorrhage.
  • Lochia starts to appear as a bloody discharge for the first 3 days after birth and is termed as lochia rubra.
  • Lochia serosa or the brownish to pinkish discharge starts on the fourth day, and the amount of blood and tissue decreases.
  • Lochia alba appears on the tenth day and the discharge decreases and almost looks colorless or whitish. It may last until the third week after birth.
  • The cervix is soft and malleable immediately after birth, but once contraction of the cervix takes place it also returns to its prepregnant state.
  • At the end of seven days, the external os has narrowed to the size of a pencil opening but appears slitlike or star shaped compared to its round shape before childbirth occurred.
  • The vagina returns to its prepregnant state through contractions after the entire postpartum period but remains slightly distended than before.
  • Kegel’s exercise helps return the strength and muscle tone of the vagina.
  • The labia minora and majora are still atrophic and soft after birth and would never return to its prepregnant state.
  • The perineum is edematous and tender immediately after birth.

Hormonal System

  • As soon as the placenta is no longer present, pregnancy hormones start to decrease.
  • hPL and hCG are insignificant by 24 hours.
  • Progestin, estrone, and estradiol return to their prepregnancy levels a week after birth.
  • FSH remains low for 12 days and then starts to increase to signal the start of a new menstrual cycle.

Urinary System

  • Immediately after birth, dieresis sets in to rid the body the excess fluid that has accumulated during pregnancy.
  • On the second to fifth day after birth, the urinary output of the woman increases to as much as 3000 mL per day.
  • The woman’s abdomen must be assessed frequently during the postpartum period to prevent damage to the bladder due to overdistention.
  • Urine may contain more nitrogen postpartum because of the increased activity of the woman during labor.
  • Lactose levels may be slightly elevated to prepare the body for breastfeeding.

Circulatory System

  • Blood volume returns to its prepregnancy level by the first or second week of birth.
  • A 4-point decrease in hematocrit and a 1-g decrease in hemoglobin occur with each 250 mL blood loss.
  • Hematocrit levels reach its normal prepregnancy level 6 weeks after birth.
  • An increase in leukocytes and plasma fibrinogen occurs in the first postpartum weeks as a defense mechanism against infection and hemorrhage.

Gastrointestinal System

  • The woman will feel hungry and thirsty almost immediately after giving birth,
  • Digestion and absorption are active again after birth except for women who underwent a caesarean section.
  • Passage of stool may still be slow because of the relaxin that is still present in the bowels.
  • Bowel evacuation may still be difficult because of the pain of episiotomy.

Practice Quiz: Postpartum Changes

Quiz time!

1. When does postpartum depression usually happens?

A. During the birth of the baby
B. One week after the delivery
C. Immediately after the delivery
D. During the letting go phase

2. What happens during the taking in phase?

A. The woman easily adjusts to her new role as a mother.
B. The woman is passive and relies mostly on the people around her.
C. The woman is very active in the care of her newborn.
D. The woman undergoes postpartum depression.

3. What is the most important player during involution?

A. Medications
B. Support persons
C. Contractions
D. Comfort measures

4. How could a woman regain the strength and tone of her vagina post birth?

A. Through pelvic rocking exercises.
B. Do Kegel’s exercises.
C. Have a hot sitz bath.
D. Apply cold compress to the area.

5. What would you advise a woman who has a urinary output of 3000 mL per day postpartum?

A. It is a normal occurrence after birth.
B. She should visit her physician and have it consulted.
C. It is a very dangerous complication postpartum.
D. She should restrict her fluids to decrease her output.

Answers and Rationale

1. Answer: D. During the letting go phase 

Postpartum depression is common during the letting go phase after birth.

2. Answer: B. The woman is passive and relies mostly on the people around her.

During the taking in phase, the woman is dependent on her healthcare providers or support persons with simple tasks and making decisions.

3. Answer: C. Contractions 

Contractions aid the return of the reproductive system to its nonpregnant state and also prevent hemorrhage postpartum.

4. Answer: B. Do Kegel’s exercises. 

Kegel’s exercise strengthens the muscle tone of the vagina.

5. Answer: A. It is a normal occurrence after birth.

The diuresis after birth gets rid of the excess fluid that has accumulated in the woman’s body during pregnancy.

These changes are what make a woman a full-fledged mother. It only takes gradual adjustment and she would easily slip into her new role as a mother without much difficulty, especially if she has a strong support system and reinforced with all the information she needs for the postpartum period.

Marianne leads a double life, working as a staff nurse during the day and moonlighting as a writer for Nurseslabs at night. As an outpatient department nurse, she has honed her skills in delivering health education to her patients, making her a valuable resource and study guide writer for aspiring student nurses.

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